Pharmacoequity and Health Outcomes Among Infants With Bronchopulmonary Dysplasia
Bibliographic record
Abstract
Abstract Rationale: Racial and ethnic disparities are associated with adverse respiratory outcomes in children with bronchopulmonary dysplasia (BPD). Inequitable prescribing practices of commonly used BPD pharmacotherapies may plausibly contribute to observed disparities in BPD respiratory outcomes. Utilizing a pharmacoequity-based approach, we aimed to investigate underlying racial/ethnic disparities in prescribing practices in the BPD population as a potential source for disparate health outcomes. Methods: We analyzed demographic, medication exposure, and respiratory support from 1,542 patients in the BPD Collaborative Outpatient Registry. Separate analyses were run for each medication exposure and by respiratory support. Chi-square tests compared medication use by sociodemographic and child health factors. Multivariable mixed logistic regression analysis, informed by causal inference framework, was utilized to estimate odds of medication exposure (primary outcome) and respiratory support (secondary outcome), by child race and ethnicity (primary exposure). Confounders were selected based on literature and data availability. Results: Infant race and ethnicity were not significantly associated with medication utilization across most chronic medications, pulmonary hypertension medications, and respiratory support type, apart from diuretics (p-value<.001), inhaled corticosteroids (p=0.016), and ventilator dependent patients support (p= 0.036) (Table 1). Compared to Non-Hispanic Black infants, Other/Multiracial infants had lower odds for diuretic use (aOR: 0.55(95% CI: 0.32, 0.92, p-value=0.024) and inhaled corticosteroids (aOR: 0.57(95% CI: 0.42, 0.78, p-value=0.024), after controlling for confounders. The odds of inhaled corticosteroid use (aOR: 0.66(95% CI: 0.53, 0.83, p-value=<.001) and supplemental oxygen dependency (aOR: 0.69(95% CI: 0.51, 0.95, p-value=0.021), were lower for those with employer-based insurance compared to patients without employer-based insurance. Conclusions: In the first pharmacoequity study in infants with BPD, we found that infant race and ethnicity were not significantly associated with medication utilization in most cases of severe BPD. However, regarding drugs for BPD management, infants classified as other/multiracial had lower odds of receiving diuretics and inhaled corticosteroids. These findings may suggest that racial disparities in medication use manifest in nuanced ways, influenced by social determinants of health like insurance status and access to care. Further research is needed to identify the mechanisms driving these observed differences to ensure equitable healthcare for all infants.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".